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INVENTORY RECONCILIATION <br />QUARTERLY SUKKARY REPORT FORK <br />isle s A��rv�Itt <br />raci . ty Name: JOHN TAY1.0R'FERI'ILIZEK5 <br />racUl.tr Addres ST P. 0. 80X 6098 <br />Telephone: <br />Person Filing ( ( J <br />Report 141 <br />Sank / Size Product <br />op 717 ,a p <br />l�t30 .p <br />JW 1 hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />Quarter. (No in Colu® 13 of the Inventory Reconciliation Sheet) <br />❑ Inventory variations exceeded the allowable limits for this Quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />r <br />uas not due to an unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List dater tank /r and amount for all variations that exceeded the <br />allowable Limits. <br />Date Tank / Anount <br />/i/ o <br />4. <br />S. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />I( the source of the variation which exceeded allowable limits was due to <br />. leak the incident shall be reported to S.J.L.H.D, Environmental Ilcalth <br />within 24 hours and an unauthorlted release report submitted. <br />the Quarterly summary report shall be aubmi(ted within 15 days of the end of each <br />Quarter. <br />Quarter I - January --) March <br />Quarter 2 - April --> June <br />Quarter 3 - July --) sep(cmh.:r <br />Q.urter 4 - October --> Ileccmbcr <br />Send to: SAN JOAQUIN LOCAL HEA1,11i DIS'I'I(ICT <br />1601 L, 1!azeltfni. P.O. Box Z(109 <br />Stockton. CA 95'101 466-67b1 <br />IJ(11' 4() 10/86 <br />